Bowel perforation injuries can occur as the result of surgical procedures; diagnostic procedures; medical conditions; and trauma. The cost to repair a bowel perforation suffered during laparoscopic surgery is minimal if that perforation is identified and treated during that surgery. The cost of reparation, as well as patient morbidity and mortality are far greater if a bowel perforation is not detected at the time of surgery. Cost and morbidity increase as time to diagnosis/intervention increases. Patients suffering undetected bowel perforations during laparoscopic surgery require additional surgery to treat the perforation. Additional diagnostic procedures, hospitalization and surgical intervention such as, CT scan, exploratory laparotomy or laparoscopy, colostomy, ileostomy, reanastomosis, antibiotic treatment, hospitalization/ICU treatment, and infectious disease consultation may also be required. The negative effects from a delay in treating bowel perforations can range from mild peritonitis to septic shock. Sepsis and septic shock can lead to hypoxia, renal failure, other major organ dysfunction and death.
Laparoscopic surgeries are performed to treat a variety of conditions in the abdominal and pelvic area, including but not limited to, exploratory biopsies, cholecystectomy, hysterectomy, hernia repair, ovarian cyst removal, and prostatectomy. Additionally, laparoscopic surgeries are being performed more routinely on patients who might previously have received open laparotomies, for example, in patients who have had previous abdominal surgeries with known adhesions, and for more complex surgeries, such as those involving large tumors, reconstructive surgeries, complex partial nephrectomies, surgeries to treat inflammatory pathological conditions, and all robotic assisted procedures.
Robotic-assisted laparoscopic procedures are also being used with increased frequency in gynecological, urological and other laparoscopic surgical procedures. This further increases the number and complexity of laparoscopic surgeries that are routinely performed. Lack of surgeon feel, as well as reduced visualization associated with robotic assisted laparoscopic procedures can contribute to the risk of bowel perforation and decrease the possibility of immediate detection.
Bowel perforation injuries are a risk associated with laparoscopic surgery. They can occur during initiation of the procedure as a Veress needle or trocar is introduced blindly into the abdominal cavity or during intraoperative dissection and cauterization. Bowel perforation injuries are not easily visualized by medical personnel during surgery due to optical limitations of the surgical equipment. Since the bowel moves during surgery, an area of injury can become positioned outside of the field of vision of the surgeon. Because of the difficulty in visualizing bowel perforations at the time of injury, there is an increased chance that the injury will not be detected during the procedure leading to the above-described negative health effects and increased costs of treatment.
In addition to surgical bowel perforations, patients may suffer trauma or ruptured diverticula causing bowel perforations that are difficult to diagnose by CT scan and clinical examination. Diagnosis relies on CT scans which can result in false negatives and clinical findings often present 24-28 hours after the onset of the infectious process. Bowel perforation is a surgical emergency. Time to diagnosis and treatment are directly correlated with morbidity/mortality and patient outcome.
There remains a need in the art to be able to detect bowel perforation. Optimally, such detection should occur near the time of injury, for example, during a laparoscopic procedure. This need and others are met by the present invention.